Healthcare Provider Details

I. General information

NPI: 1922345578
Provider Name (Legal Business Name): THE SENIOR'S CLUB LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 CENTENNIAL DR
TINLEY PARK IL
60477-1649
US

IV. Provider business mailing address

7040 CENTENNIAL DR
TINLEY PARK IL
60477-1649
US

V. Phone/Fax

Practice location:
  • Phone: 708-444-7463
  • Fax: 708-444-8359
Mailing address:
  • Phone: 708-444-7463
  • Fax: 708-444-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LENORA ANN MILLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 708-444-7463